Showing posts from May, 2006

Autism, reality, and adaptability

What makes our environments real, or not real? And when we are working with people who have autism, in what way should we be defining the reality of their experience?

This matters because I was roasting Snoezelen a while back, and perhaps that is not fair. We need to have the debate first on what is real, and what is not real.

Sorry if this rambles, but here is my stream of consciousness: after watching a simulated combat/virtual reality training system on the news the other day I did some research on use of virtual reality environments for real-context performance enhancement. That led me to a story that reported that doctors who played many video games were better/more proficient at laparoscopic surgery than those who did not play video games.

This makes logical sense to me.

Then I got to thinking that there is some mechanism at work that makes skill sets improve or change in order to meet demands. This is related to the entire idea of evolution, that holds out that the species grows an…

Things that go into private practice that you didn't think about

Small projects never end when you are in private practice. Some are practice oriented and others are just plain annoying - but you can't always measure the criticality of something that needs to be done by the relative value that you are inclined to place on it.

In other words, sometimes you have to do things and label them as critical even though it really doesn't matter to you. Or even if it seems intuitive and shouldn't require labeling or undue attention.

In short, your opinion does not always matter. There are Gods to answer to, and they demand attention.

Entire afternoons can pass me by as I answer the whimsical calls of demanding Gods. Sometimes it is the call of a municipality who needs a 30th copy of malpractice insurance. Sometimes it is the call of an auditing or survey team, asking for clarification on item 27, subpart b, page 2, of a triplicate-submitted corrective action plan. Sometimes it is the dazed and confused compensation carrier who doesn't understand…

Llamas, goats, and animal assisted therapy, Part II

Back in November of last year I wrote about an experience I had providing expert testimony on a land-use case, where a family wanted to keep their pet llamas and goats available for their child who has autism, despite not being able to obtain a variance from the local zoning board. For purposes of background, you can (re)read that story here.

I picked up the latest American Journal of Occupational Therapy this morning and was interested to find an article by Mona Sams, Elizabeth Fortney, and Stan Willenbring. The article describes a pilot study incorporating animals in OT sessions for children who have autism (Sams, Fortney, & Willenbring, 2006).

Basically, the study neasures incidence of language use and social interaction in therapy sessions that incorporate animals vs. therapy sessions without animals. I applaud the effort because this is one of those anecdotal issues where most people agree that animals can be an effective methodology, but there really is a lack of good research…

Question of the day: Should we allow institutional abuse of children?

Although this advice is unsolicited, I am not above trying to help out New York State's Board of Regents. They are seeking input from school Superintendents and Executive Directors of private schools and preschools about the use of aversive or noxious stimuli to reduce or eliminate student behaviors. I am neither a Superintendent or an Executive Director of a school, but I thought I could offer a little advice.

The Board of Regents sent out their first memo where they asked for information about agency or school use of 'aversive therapies.' Apparently, aversive therapies can include
Noxious, painful, intrusive stimuli or activities intended to induce pain such as hitting, slapping, pinching, kicking, hurling, strangling, shoving, or other similar stimulus Any form of noxious, painful or intrusive spray or inhalant Any form of noxious tastes Electric shock Water spray to the face Pinches and deep muscle squeezes Withholding sleep, shelter, bedding, bathroom facilities, cloth…

In New York State, not all "developmental disabilities" are equal

I was taken aback today when a parent indicated to me that her child was being reviewed for continued eligiblilty by New York State's Developmental Disabilities Service Office. This child has severe learning disabilities caused by a congenital neurological condition.

I was taught that a developmental disability was defined as a condition that was manifest in the developmental period (generally before age 22) and caused substantial limitation in functional ability. Qualifying conditions typically included cerebral palsy, autism, epilepsy, mental retardation, and learning disabilities. Along the way, I was aware that people who had traumatic brain injuries were also added to this list.

Wondering if there was some need for me to update my definition of developmental disabilities, I went to the NY State Office of Mental Retardation and Developmental Disabilities Website and found an interesting answer to my question: What are developmental disabilities? According to the website (in case…

Probability theory and CSE meetings

I am not a mathematician, but I have a basic understanding of the concept of probability. Given my uneven degree of skill in shooting arrows, if I am to pick up a bow and aim it toward a bullseye you can apply laws of probability to determine where the arrow will hit, or in which direction it will miss, the target.

This of course assumes a 'fair' set of circumstances. Also, one would probably need to apply the law of large numbers because there is always the odd chance that I could hit a bullseye on my first attempt.

I am thinking about this because it is that time of year when parents ask we to attend CSE meetings with them. Almost invariably, the parents are not satisfied with the educational program that is being offered by the school. After 18 years of practice, I still have not had a parent come to me indicating that they need my help to get the school to offer less services, or a more compacted and efficient plan.

I am relatively certain that my practice is attracting a sma…

Autism prevalence

Whenever something is published about autism prevalence my email box overflows with notes from parents and colleagues about the 'latest study.' I couldn't even escape the prevalence question when we did the television spot on AM Buffalo: of course someone called in with this question. People always want to know why there are more diagnosed cases.

The latest study is a new CDC prevalence study on autism that has been published in the May 5, 2006 issue of the “Morbidity and Mortality Weekly Report.” Results from the two surveys suggest that as of 2004, autism had been diagnosed in at least 300,000 children aged 4-17. I have done a fair amount of reading on this topic and thought it would be interesting to share some of the other prevalence studies that have been recently published. They are listed below in 'References.'

It is all as clear as mud, of course. Bottom line: there are more diagnosed cases of autism, some of them are geographically concentrated, and this is …

The differences between adults and children

Another obvious entry - perhaps. I used to work in a children's hospital and I enjoyed spending time in the orthopedic clinics. I particularly enjoyed splinting, casting, and fracture bracing. The best part was that despite having broken bones the kids were almost universally interested in getting back to their typical occupations. It was important to work with the orthopedic surgeon to make sure there was appropriate stability, but then we got to educate the family on how to reign in the energy of a 3 year old even though they had a long leg cast on, or talk about how to secure the child in a car seat with the cast, or how to take care of toileting needs. The interventions were direct, practical, and there was almost always the exact result that you expected. Kids heal well, they heal fast, and they don't like to wait while that healing process is proceeding.

I contrast this to working with adults who (as a population) respond very differently to a fracture than a child. Adult…

Entre nous

I was reminded several times today that people are different. That is really an obvious statement but it is so simplistic that I think it is important to remind ourselves of this fact.

Sometimes the simplest things slip by us the easiest.

Personal context is important to consider – otherwise the world begins to look very grim and automated. Several non-occupational therapy contributions to the scientific literature had a significant influence on occupational therapy’s move away from reductionistic models. For example, Boulding (1968) and von Berrtalannfy (1968) wrote comprehensively on the subject of general systems theory, which refocused science’s focus away from increasingly narrower ranges of perspective. Boulding also wrote about the power of subjective knowledge and its influence on all of human behavior (1966). Although I don’t believe that any of these authors are routinely cited in the occupational therapy literature, their contributions to changes in scientific thinking are re…

More on 'why he writes'

One of the most common questions I get in email regarding this blog is “Chris, …why?” So in consideration of offering more/follow-up reasons on ‘why he writes’ I offer you this to consider:

We are in the middle of the beginnings of a New Renaissance, although you might not have noticed. Computers and the Internet have changed our lives - nothing will ever be the same again. This has broad social and cultural application - probably more fodder for another day - but I wanted to stick to the issues related to the New Revolution and writing.

All of this happened before: that is the interesting pattern of history. The Northern Renaissance followed the Italian tradition of literature that was printed in the common language of local people. This simple change in literature away from the Latin language had a profound effect on the development of regional cultures and the identities of the people who lived in the respective geographic regions.

Most notable of Northern Renaissance writing would b…